SIHF Vitenarkiv
Not a member yet
590 research outputs found
Sort by
Long-term outcome of sphincteroplasty with separate suturing of the internal and the external anal sphincter
Get PDFAbstract Background Sphincteroplasty is one of the treatment options for anal incontinence following obstetric injury. The aim of the study was to evaluate the long-term efect of sphincteroplasty with separate suturing of the internal and the external anal sphincter on anal continence. Methods A retrospective study was conducted on women who had sphincteroplasty for treatment of anal incontinence following obstetric injury. Women operated between January 1, 2011 and December 31, 2014 at Sykehuset Innlandet Hospital Trust Hamar, were invited to answer a questionnaire and participate in a clinical examination, including endoanal sonography. Results 111 (86.7%) women participated. Median postoperative follow-up was 44.5 months, and 63.8% of the participants experienced an improvement of at least three points in the St. Mark’s incontinence score. Fecal urgency and daily fecal leakage persisted in 39.4% and 6.4% of the participants, respectively. The internal anal sphincter improvement persisted in 61.8% of the participants, and there was a median reduction of their St. Mark’s score of 6.0 points between the preoperative value and the value at long-term follow-up. There was no signifcant change in the St. Mark’s score of patients with persistent dehiscence of the internal anal sphincter. Conclusions Sphincteroplasty, with separate suturing of the internal sphincter resulted in continence for stool maintained for at least 3 years in the majority of the patients, while there was an improvement in continence in nearly two-thirds. Keywords Anal incontinence · Obstetric anal sphincter injury · Sphincter repairAll fnancial support of this study has been granted by Innlandet Hospital Trust. The funder was not involved in the study design,
the data collection, data analysis, data interpretation or in the writing
of the report. The corresponding author had full access to all the data
and the fnal decision to submit the study for publication.publishedVersio
Centres for Development of Institutional and Home Care Services (CDIH) in Norway
Get PDFHensikten med studien er å få mer kunnskap om hvordan utviklingssentrene for sykehjem og hjemmetjenester (USHT) opplever sin rolle som pådrivere for utvikling, implementering og spredning av ny kunnskap i de kommunale helse- og omsorgstjenestene, og hvordan de opplever samarbeidet med Senter for omsorgsforskning (SOF) når det gjelder forskningsfaglig bistand og veiledning. Vi søker gjennom dette å bidra til ny kunnskap om samarbeidsbasert innovasjonsarbeid i skjæringsfeltet mellom statlige føringer, forskning og praksis. Undersøkelsen er gjennomført som en questback-undersøkelse med både lukkede og åpne svaralternativer sendt til alle USHT. Resultatene viser at USHT er ulike når det gjelder oppbygging, organisering, antall ansatte, kompetanse og fagsammensetning. Disse ulikhetene har betydning for både deltakelse og fokus i innovasjons- og FoU-arbeidet som foregår i de ulike sentrene og for samarbeidet med SOF. En tettere dialog mellom Helsedirektoratet, USHT og SOF om forventninger og behov, samt en konkretisering av rammer for samarbeidet, vil kunne bidra til utvikling av en mer hensiktsmessig struktur for utvikling, implementering og spredning av ny kunnskap i helse- og omsorgstjenestene. Nøkkelord: Samarbeid, Innovasjon, FoU-arbeid, Senter for omsorgsforskning utviklingssentrene for sykehjem og hjemmetjenesterThe aim of the study is twofold: First, it aims to investigate how the Centre for Development of Institutional and Home Care Services (CDIH) experiences their role as a driving force for the development, implementation and dissemination of new knowledge in the municipal health and care services. Second, it aims to explore how the CDIH experiences the collaboration with the Centre for Care Research (CCR) and the research-related assistance and supervision they provide. We seek to provide new insights into cooperation-based innovation efforts in the intersection between governmental leadership, research and practice. The study draws on data from a questback survey with both closed and open-ended questions distributed to all CDIH departments. The results show that the CDIH differs in terms of structure, organization, number of employees and competence. This is important for research & development work in the various CDIH departments, and for cooperation with the CCR. A closer dialogue between the Norwegian Directorate of Health, the CDIH and the CCR about expectations and needs, as well as a concrete framework for cooperation, can contribute to the development of a more appropriate structure for the development, implementation and dissemination of new knowledge in the municipal health and care services.publishedVersio
Inhaled nitric oxide might be a contributing tool for successful resuscitation of cardiac arrest related to pulmonary hypertension
Get PDFWe describe a case where inhaled nitric oxide (iNO) was successfully initiated during cardiopulmonary resuscitation (CPR) in a younger patient with cardiac arrest related to pulmonary hypertension after disseminated intravascular coagulation (DIC) postpartum bleeding and hysterectomy. This case illustrates that iNO might be a potential lifesaving tool for resuscitation of patients with cardiac arrest related to pulmonary hypertension, for whom most other resuscitation strategies often are futile.publishedVersio
Farm-based day care services – a prospective study protocol on health benefits for people with dementia and next of kin
Get PDFIntroduction: The increasing number of people with dementia will place a considerable challenge on the health care system and will necessitate innovation and new solutions. Day care services aim to provide meaningful activities and coping experiences for the target group. The aim of the present study is to explore the experience and potential health benefits for people with dementia attending farm-based day care services in Norway and their next of kin. Methods and design: The present study is a prospective study organized into several qualitative and quantitative sub-studies. Study period will last from 2016–2020. We use a multi-method approach and both an empirical and a constructivist view on knowledge to explore this multi-facetted phenomenon. Discussion: Several challenges are expected, for instance, the ability to include participants with dementia and keep them within the study for the whole study period. The functioning level of participants regarding language and understanding could challenge their ability to answer. Despite having several limitations, we believe that this study with its different approaches and methods will add important knowledge to the field. Knowledge from our study could be essential for creating day care services of good quality for people with dementia and such services could reduce the burden of care for their next of kin. Keywords: care farms, coping, farm-based activities, green care, meaningful activities, multi-method approachThe present study is supported by the Research Council of Norway, grant number 255033.publishedVersio
Gut microbiota composition during a 12-week intervention with delayed-release dimethyl fumarate in multiple sclerosis – a pilot trial
Get PDFIntroduction: Patients with multiple sclerosis may have a distinct gut microbiota profile. Delayed-release dimethyl fumarate is an orally administered drug for relapsing-remitting multiple sclerosis, which has been associated with gastrointestinal side-effects in some patients.
Objectives: The purpose of this study was to determine if dimethyl fumarate alters the abundance and diversity of commensal gut bacteria, and if these changes are associated with gastrointestinal side-effects.
Methods: Thirty-six patients with relapsing-remitting multiple sclerosis received either dimethyl fumarate (n = 27) or an injectable multiple sclerosis disease-modifying therapy (glatiramer acetate or interferons, n = 9) for 12 weeks. Stool samples were collected at baseline, two and 12 weeks. We included 165 healthy individuals as controls.
Results: At baseline, 16 microbial genera were altered in multiple sclerosis patients compared with healthy controls. In the dimethyl fumarate-treated patients (n = 21) we observed a trend of reduced Actinobacteria (p = 0.03, QFDR = 0.24) at two weeks, mainly driven by Bifidobacterium (p = 0.06, QFDR = 0.69). At 12 weeks, we observed an increased abundance of Firmicutes (p = 0.02, QFDR = 0.09), mostly driven by Faecalibacterium (p = 0.01, QFDR = 0.48).
Conclusions: This pilot study did not detect a major effect of dimethyl fumarate on the gut microbiota composition, but we observed a trend towards normalization of the low abundance of butyrate-producing Faecalibacterium after 12 weeks treatment. The study was underpowered to link microbiota to gastrointestinal symptoms.The author(s) disclosed receipt of the following financialsupport for the research, authorship, and/or publicationofthis article: This work was supported by Biogen. This clinical trial is registered at clinicaltrials.gov (identifier NCT02471560).publishedVersio
Creating room for evidence-based practice: Leader behavior in hospital wards
Get PDFAbstract The integration (routinizing and sustaining) of evidence-based practice (EBP) into hospital management is a key element for improving patient safety and ensuring better patient outcomes. Hospital managers and clinical leaders play crucial roles in this integration. Interactions between leaders and integration context influence the improvement's quality, but leader-based actions that are effective for improving nursing practice remain unclear. The relationship between leaders could also either hinder or enable this implementation process. The aim of this study was to generate a theory about patterns of leader behavior that leaders are engaged in when attempting to integrate EBP in a clinical setting. We used a classic grounded theory methodology to generate a substantive EBP theory. In this study, through participant observation, we observed 63 nurses (15 specialist, 39 registered, and 9 assistant nurses). From these, five ward leaders (two head nurses, one assistant head nurse, and two teaching nurses) participated in individual interviews, and 18 clinical nurses participated in four focus groups. "Creating room for EBP" emerged as a theory for explaining the way in which the leaders attempted to resolve their main concern: How to achieve EBP treatment and care with tight resources and without overextending the nurses. Creating room for EBP encompasses a process of interactions, including positioning for, executing, and interpreting responses to EBP.publishedVersio
Basic Self-Disturbances Independently Predict Recovery in Psychotic Disorders: A Seven Year Follow-up Study
Get PDFBackground Recovery is the ultimate goal of psychosis treatment . Basic self-disturbances (BSDs) are non-psychotic phenomena associated with clinical outcome, present in prodromal, psychotic and residual phases of psychotic disorders. Aim To investigate the relationship between BSDs and recovery seven years after first treatment in patients with psychotic disorders. Method Prospective longitudinal study of 56 patients recruited during first adequate treatment for schizophrenia (n = 35) and other psychotic disorders (n = 21) (psychotic bipolar disorder, delusional disorder, psychotic disorder NOS). At baseline and follow-up BSDs were assessed using the Examination of Anomalous Self-Experience (EASE) manual, while standard clinical instruments were used to ascertained diagnosis, clinical symptom severity, and functioning. Recovery was defined as absence of psychotic symptoms and regaining of functioning that persisted the last two years before follow-up. Results At follow up, 34% achieved recovery (5 (14%) with schizophrenia and 14 (67%) with other psychoses at baseline). Recovery was predicted by an absence of a schizophrenia diagnosis, low baseline level of BSDs and further reductions in BSDs from baseline to follow-up. Change in BSDs was the strongest predictor, also after adjusting for premorbid adjustment and duration of untreated psychosis, and was not confounded by diagnosis. Conclusion Low baseline levels of basic self-disturbances and further reductions over time independently predict recovery seven years later in first treated psychosis patients.This work was supported by Innlandet Hospital Trust, Norway
(Grant Nos. 150281 and 150338), and Eastern Norway Health Authority (Grants no. 2006258-2011085-2014102). BN was supported
by an NHMRC Senior Research Fellowship (Grant no. 1137687).acceptedVersio
Quality of Life in People with Young-Onset Dementia: A Nordic Two-Year Observational Multicenter Study
Get PDFBackground:Cross-sectional studies of quality of life (QOL) of people with young-onset dementia show diverging results. Objective:To identify factors associated with QOL in people with young-onset Alzheimer’s (AD) and frontotemporal dementia (FTD) and explore development in QOL over a two-year period, including differences between the two subtypes. Methods:A two-year cohort study of 88 community-dwelling people with young-onset AD and FTD recruited from Nordic memory clinics. QOL was assessed using the proxy version of the Quality of Life – Alzheimer’s Disease questionnaire, dementia severity was rated with the Clinical Dementia Rating scale, depressive symptoms by the Cornell Scale for Depression in Dementia, awareness with the Reed anosognosia scale, and needs using the Camberwell Assessment of Needs in the Elderly questionnaire. Factors associated with QOL and development in QOL over time were explored with growth mixture model trajectories and mixed model analyses. Results:We identified two groups of people following trajectories with better (n = 35) versus poorer (n = 53) QOL. People with more depressive symptoms at baseline had higher odds of belonging to poorer QOL group, OR 1.2 (CI 1.1; 1.5, p = 0.011). Having Alzheimer’s disease was associated with significantly better QOL (p = 0.047 at baseline, p = 0.009 at T1 and p = 0.033 at T2). Increasing number of unmet needs was significantly associated with poorer QOL at baseline (p = 0.007), but not later in follow-up. Conclusion:Early assessment and treatment based on dementia subtype, depression, and individual needs may enhance quality of life in young-onset dementia.
Keywords: Alzheimer’s disease, depression, frontotemporal dementia, quality of life, young-onsetsubmittedVersio
CAM-type femoroacetabular impingement in male elite junior cross-country skiers and non-athlete controls: A cross-sectional MRI study
Get PDFOBJECTIVES: Cross-country (CC) skiing consists of two main techniques: classic and skating. Hip motion during the skating technique is similar to that in ice skating and is considered a risk factor for femoroacetabular impingement (FAI) in ice hockey players. We aimed to compare the presence of CAM-type FAI in a cohort of elite junior CC (EJCC) skiers with a control group of non-athlete (NA) high school students. METHODS: Observational cohort study: EJCC skiers and NAs were recruited from a sports school and a regular high school, respectively. Baseline demographics and training history were obtained via a questionnaire. Bilateral hip MRI was performed and the alpha angle was measured in three planes. CAM deformity was defined as an alpha angle>55° on at least two MRI planes per hip. RESULTS: A total of 20 EJCC skiers and 10 NAs participated. All participants were male, aged 16-19 years. Average training volume was 528.10±68.34 hours per year for the EJCC skiers compared with 153.50±57.09 for the NAs (p<0.001). The prevalence of CAM deformity in at least one hip on MRI was 50% in both groups (10 CC skiers and 5 NAs). The average alpha angles were 52.4±6.1° in the EJCC group and 52.5±4.9° in the NA group (p=0.94). CONCLUSION: Radiographic evidence of CAM-type FAI was not more common in the CC skiers compared with NAs. The type, rather than volume or intensity of training, maybe a more important risk factor for the development of CAM-type FAI in young athletes.The authors have not declared a specific grant for this research from any
funding agency in the public, commercial or not-for-profit sectors.publishedVersio
Temporal changes in cardiorespiratory fitness and risk of dementia incidence and mortality: a population-based prospective cohort study
Get PDFCardiorespiratory fitness is associated with risk of dementia, but whether temporal changes in cardiorespiratory fitness influence the risk of dementia incidence and mortality is still unknown. We aimed to study whether change in estimated cardiorespiratory fitness over time is associated with change in risk of incident dementia, dementia-related mortality, time of onset dementia, and longevity after diagnosis in healthy men and women at baseline. Methods We linked data from the prospective Nord-Trøndelag Health Study (HUNT) done in Nord-Trøndelag, Norway with dementia data from the Health and Memory Study and cause of death registries (n=30 375). Included participants were apparently healthy individuals for whom data were available on estimated cardiorespiratory fitness and important confounding factors. Datasets were matched to each participant through their 11-digit personal identification number. Cardiorespiratory fitness was estimated on two occasions 10 years apart, during HUNT1 (1984–86) and HUNT2 (1995–97). HUNT2 was used as the baseline for follow-up. Participants were classified into two sex-specific estimated cardiorespiratory fitness groups according to their age (10-year categories): unfit (least fit 20% of participants) and fit (most fit 80% of participants). To assess the association between change in estimated cardiorespiratory fitness and dementia, we used four categories of change: unfit at both HUNT1 and HUNT2, unfit at HUNT1 and fit at HUNT2, fit at HUNT1 and unfit at HUNT2, fit at both HUNT1 and HUNT2. Using Cox proportional hazard analyses, we estimated adjusted hazard ratios (AHR) for dementia incidence and mortality related to temporal changes in estimated cardiorespiratory fitness. Findings During a median follow-up of 19·6 years for mortality, and 7·6 years for incidence, there were 814 dementia-related deaths, and 320 incident dementia cases. Compared with participants who were unfit at both assessments, participants who sustained high estimated cardiorespiratory fitness had a reduced risk of incident dementia (AHR 0·60, 95% CI 0·36–0·99) and a reduced risk of dementia mortality (0·56, 0·43–0·75). Participants who had an increased estimated cardiorespiratory fitness over time had a reduced risk of incident dementia (AHR 0·52, 95% CI 0·30–0·90) and dementia mortality (0·72, 0·52–0·99) when compared with those who remained unfit at both assessments. Each metabolic equivalent of task increase in estimated cardiorespiratory fitness was associated with a risk reduction of incident dementia (adjusted HR 0·84, 95% CI 0·75–0·93) and dementia mortality (0·90, 0·84–0·97). Participants who increased their estimated cardiorespiratory fitness over time gained 2·2 (95% CI 1·0–3·5) dementia-free years, and 2·7 (0·4–5·8) years of life when compared with those who remained unfit at both assessments. Interpretation Change in estimated cardiorespiratory fitness is an independent risk factor for incidence dementia and dementia mortality. Maintaining or improving cardiorespiratory fitness over time may be a target to reduce risk of dementia incidence and mortality, delay onset, and increase longevity after diagnosis. Our data highlight the importance of assessing cardiorespiratory fitness in health risk assessment for people at risk of dementia.The KG Jebsen Foundation, the Norwegian Research Council, the Liaison Committee between the Central Norway Regional Health Authority, and the Norwegian University of Science and Technology.publishedVersio